The End of NIHR ARC West Midlands, 2009-2026

Not without some sadness I deliver the final blog of the NIHR ARC West Midlands. This is the last of 183 blogs (51 ARC, 132 CLAHRC) over 17 years of Applied Research Collaborations.

The reasons for ending the blog are two-fold:

Firstly, the blog is ARC-funded and the income stream terminates at the end of March 2026. Blog manager Peter Chilton will now transfer to the NIHR Reducing Delays in Cancer Care in sub-Saharan Africa research award, funded by the Global Health Policy & Systems Research programme.

Second, it has occurred to me that blogging is no longer the optimal dissemination method. So, I shall be turning to my LinkedIn page at linkedin.com/in/richard-lilford-0a1b5a3b/. I plan to post frequently and hope to engage with you in this form.

And what of 17 years at the ARC helm?

It was good while it lasted, but I do not regret my decision to stand back from the ARC. Seventeen years holding the collaboration together and ensuring that the total was greater than the sum of its parts is a constant effort, and is more of a management than a research endeavour. I am however, please with the NHS and local authority links that we have developed – we were always first or second among CLAHRCs/ARCs in the amount of co-funding we garnered from the service; this was always more than the £2m per year from the NIHR. I am eternally grateful to Paul Bird (ARC WM Head of Programme Delivery) for the hours he put in cementing these relationships and making sure that the co-funding was fully auditable.

I am very grateful for the opportunity to direct our three centres and hope I did a reasonable job.

What Did We Achieve?

1. The step-wedge design movement was built entirely around the Applied Research Collaborations. We are the most highly-cited group in the world on this topic according to a recent systematic review from the US,[1] and our work was used as an Impact Case Study by the University of Birmingham (mathematics) in the last Research Excellence Framework (REF) in 2021.[2]

2. Mental health. The child-adolescent service in Birmingham was designed in line with evidence from our first CLAHRC Birmingham & Black Country (BBC), where we showed that the duration of untreated psychosis could be reduced by overcoming service barriers.[3] We have now implemented a city-wide psycho-prophylaxis programme in the city of Birmingham (SchoolSpace),[4] thanks to Max Birchwood, Swaran Singh and Domenico Giacco.

3. Measurement of patient safety. As Lord Kelvin said, “when you cannot measure it,… your knowledge is… meagre and unsatisfactory.” I believe that we have published more on this topic than anyone else in the world, along with our colleague Tim Hofer from University of Michigan.[5-9] Our recent BMJ paper [10] resulted in the UK Secretary for Health calling us ‘elitist’ [11] – an impact of a sort! Likewise, we have published a series of articles using statistical techniques to detect tell-tale discontinuities that signal manipulation of NHS data in response to targeted incentives.[12-15]

4. In our earlier studies we showed that targeted incentives can work – the West Midlands improved from having the lowest to highest rates of home dialysis as a result of a financial disincentive.[16] However, the above studies show that they fail or backfire if the measures are unreliable or invalid, or if the service does not know what to do to reach the incentive threshold.

5. Our work on Equality, Diversity and Inclusion and Patient and Public Involvement and Engagement stands out because not only have we established active and acclaimed programmes, but we have led intellectually in developing the field.[17-21]

6. We have always been in the top two or three CLAHRCs/ARCs for bringing in additional NIHR and other funding. Examples are Julian Bion’s grant on seven-day working, which was the largest HS&DR grant ever awarded and resulted in a Lancet paper,[22] and a series of two programme grants (RPPG-1209-10099 and RP-PG-0617-20009) on electronic prescribing with Prof Sir Aziz Sheikh and Prof Jamie Coleman. The NIHR Midlands Patient Safety Research Collaboration (PSRC) was one of the many offspring from the ARC WM; as is the BADGER study, building an evidence base for the use of Advice and Guidance at the primary-secondary care interface, and the PROMPPT pain management programme both based at Keele University.

7. We have established a substantial overseas portfolio based on Implementation Science methods developed originally in our Collaborations, leading to numerous papers in Lancet stable journals.[23-26] This work took off when I was working at the University of Warwick establishing the Global Health Research Centre, and I shall always be grateful to that university for the opportunity to generalise the applied research method. For example, we are developing and evaluating a series of interventions to reduce delay in cancer diagnosis and treatment in East and West Africa under a £4m NIHR grant (NIHR158242).

8. We changed practice across the whole country, for example:

i. Sara Kenyon’s Birmingham Symptomspecific Obstetric Triage System (BSOTS) service to triage maternity admissions is now universally applied across England and has been adopted abroad. The service was implemented to avoid the documented problem that unborn babies were dying while their mothers waited their turn to be seen in busy services.[27]

ii. Our work on implementation of Statistical Process Control (SPC) charts has also been adopted through our collaboration with Samantha Riley of Making Data Count in NHS England – the evaluation of this programme has been documented in a series of three articles,[28-30] and we have an affidavit from NHS England that the nationwide initiative was inspired by our work.[31]

iii. The work led by University of Warwick on Pathways to Implementation for Public Engagement in Research (the PIPER study), which has seen development and deployment of a toolkit that enables individuals and/or groups to plan and undertake tailored implementation activities with patients and the public.[32]

The above represents just a flavour of our achievements – a more comprehensive account for just the ARC West Midlands can be found at: https://www.arc-wm.nihr.ac.uk/ wp-content/uploads/2026/02/ARC-WMLegacy-2019-2026.pdf.

Our collaboration spanned three universities and numerous provider organisations, including our host University Hospitals Birmingham NHS Foundation Trust. It all started when Julie Moore (Chief Executive, UHBFT) and Michael Sheppard (Provost, UoB) invited me to lead the first bid back in 2008. Thanks to Graeme Currie and Christian Mallen, we incorporated the Universities of Warwick and Keele for our second and third bids. I thank these individuals and their organisations for many years of fruitful engagement.

I must give my sincere thanks to Jo Sartori who has supported me from the very first centre and helped me manage the arduous application process – also managers Jo Foster, Nathalie Maillard, Anne-Marie Brennan, Phil Simmons and Jennifer Knight. Lastly, Melita Harris who has been at my side throughout and Peter Chilton who produces the blog, among many other contributions.

— Richard Lilford, ARC WM Director

References:

  1. Murray DM. Influential methods reports for group-randomized trials and related designs. Clin Trials. 2022; 19(4): 353-62.
  2. University of Birmingham. Impact case study (REF3): Statistics research underpins methodological standards and design tools for efficient and informative trial of healthcare interventions. 2021.
  3. Birchwood M, Connor C, Lester H, et al. Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. Br J Psychiatry. 2013; 203(1): 58-64.
  4. Chisholm K, Patterson P, Torgerson C, et al. Impact of contact on adolescents’ mental health literacy and stigma: the SchoolSpace cluster randomised controlled trial. BMJ Open. 2016; 6: e009435.
  5. Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 1. Conceptualising and developing interventions. Qual Saf Health Care. 2008; 17(3): 158-62.
  6. Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 2. Study design. Qual Saf Health Care. 2008; 17(3): 162-9.
  7. Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurement. Qual Saf Health Care. 2008; 17(3): 170-7.
  8. Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 4. One size does not fit all. Qual Saf Health Care. 2008; 17(3): 178-81.
  9. Lilford RJ, Hofer TP. Regulation of health facilities: often criticised but seldom evaluated. BMJ. 2024; 387: q2388.
  10. Lilford RJ, Chen Y-F, Sutton M, Hofer T. Hospital League Tables, Targets and Performance Incentives Should Be Used with Care. BMJ. 2025; 389: e083517.
  11. Iacobucci G. Flawed NHS league tables won’t help patients and could punish struggling trusts, experts warn. BMJ. 2025; 390: r1911.
  12. Quinn L, Bird P, Remsing S, Reeves K, Lilford R. Unintended consequences of the 18week referral to treatment standard in NHS England: a threshold analysis. BMJ Qual Saf. 2023; 32(12): 712-20.
  13. Quinn L, Bird P, Lilford R. Effect of cancer waiting time standards in the English National Health Service: a threshold analysis. BMC Health Serv Res. 2024; 24(1): 929.
  14. Quinn L, Bird P, Hofer TP, Lilford R. Cancelled elective operations and 28-day breaches in the NHS in England: an interrupted time series analysis of the 2002 penalty policy, 2008 recession, and COVID-19 pandemic (1994-2023). Lancet Reg Health Eur. 2025; 56: 101368.
  15. Kudrna L, Yates J, Alidu L, et al. A Mixed-Methods Cluster Randomised Waitlist-Controlled Trial of a Goal-Based Behaviour Change Intervention Implemented in Workplaces. Int J Environ Res Public Health. 2025; 22(3): 398.
  16. Combes G, Allen K, Sein K, Girling A, Lilford R. Taking hospital treatments home: a mixed methods case study looking at the barriers and success factors for home dialysis treatment and the influence of a target on uptake rates. Implement Sci. 2015; 10: 148.
  17. Staniszewska S, Hopewell S, Richards DP, Chidebe RCW. Patient and public involvement in research reporting. BMJ. 2025; 389: r647.
  18. Staniszewska, S, et al. GRIPP2 reporting checklist: tools to improve reporting of patient and public involvement in research. BMJ. 2017; 358: j3453.
  19. Retzer A, et al. A toolkit for capturing a representative and equitable sample in health research. Nat Med. 2023; 29: 3259-67.
  20. Skrybant M & Campbell N. “It’s not just hard work, it’s heart work.” ARC WM’s approaches to establishing and sustaining links with diverse communities across the West Midlands. NIHR ARC West Midlands News Blog. 2022; 12(6) 11-13.
  21. Skrybant M & Lilford R. PCIEP in ARC West Midlands. NIHR ARC West Midlands News Blog. 2019; 1(1): 7-8.
  22. Aldridge C, Bion J, Boyal A, et al. Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. Lancet. 2016; 388(10040): 178-86.
  23. Lilford RJ, Oyebode O, Satterthwaite D, et al. Improving the health and welfare of people who live in slums. Lancet. 2017; 389(10068): 559-70.
  24. Ezeh A, Oyebode O, Satterthwaite D, et al. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet. 2017; 389(10068): 547-58.
  25. Lilford RJ, Daniels B, McPake B, et al. Supply-side and demand-side factors affecting allopathic primary care service delivery in low-income and middle-income country cities. Lancet Glob Health. 2025; 13(5): e94253.
  26. Lilford RJ, Daniels B, McPake B, et al. Policy and service delivery proposals to improve primary care services in low-income and middle-income country cities. Lancet Glob Health. 2025; 13(5): e954-66.
  27. Kenyon S, Hewison A, Dann SA, et al. The design and implementation of an obstetric triage system for unscheduled pregnancy related attendances: a mixed methods evaluation. BMC Pregnancy Childbirth. 2017; 17(1): 309.
  28. Kudrna L, et al. Retrospective evaluation of an intervention based on training sessions to increase the use of control charts in hospitals. BMJ Qual Saf. 2023; 32(2): 100-8.
  29. Schmidtke KA, et al. Considering chance in quality and safety performance measures: an analysis of performance reports by boards in English NHS trust. BMJ Qual Saf. 2017; 26(1): 61-9.
  30. Schmidtke KA, et al. Cluster randomised evaluation of a training intervention to increase the use of statistical process control charts for hospitals in England: making data count. BMJ Qual Saf. 2025; 34: 621-30.
  31. Riley S. Testimonial – Making Data Count. 2025. https://www.arc-wm.nihr.ac.uk/ testimonial-making-data-count/
  32. Staniszewska S, et al. Developing a role for patients and the public in the implementation of health and social care research evidence into practice: the PIPER study (Pathways to Implementation for Public Engagement in Research) realist evaluation protocol. Res Involv Engagem. 2025; 11(1): 80.

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